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June 2006

Cutaneous Manifestations of Visceral Leishmaniasis Resistant to Liposomal Amphotericin B in an HIV-Positive Patient

Arch Dermatol. 2006;142(6):781-798. doi:10.1001/archderm.142.6.787

A 48-year-old man with cutaneous Kaposi sarcoma and infected with human immunodeficiency virus (HIV) was diagnosed as having visceral leishmaniasis (VL). The patient presented with fever, weight loss, hepatosplenomegaly, and pancytopenia. At the time of the VL diagnosis, his CD4 cell count was 69 cells/μL (viral load, 578 RNA copies/mL), and he was receiving double nucleoside therapy for a previous symptomatic anemia. Parenteral therapy with meglumine antimoniate (20 mg/kg per day) was administered for 1 month. Antiretroviral therapy was concomitantly changed to a triple regimen. There was clinical improvement with complete VL remission. Eight months later, with a CD4 cell count of 98 cells/μL (viral load, <200 RNA copies/mL), the VL relapsed. He was treated with liposomal amphotericin B (4mg/kg per day) for 1 month with favorable clinical outcome confirmed by bone marrow aspirate. Secondary prophylaxis with liposomal amphotericin B at 4 mg/kg every 14 days was maintained.